Identifying the approaches used by audiologists to address the psychosocial needs of their adult clients.

OBJECTIVE: To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss. DESIGN: A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other. STUDY SAMPLE: An international sample of 65 audiologists. RESULTS: Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility. CONCLUSIONS: Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice.

Audiological approaches to address the psychosocial needs of adults with hearing loss: perceived benefit and likelihood of use.

OBJECTIVE: To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss. DESIGN: Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss. STUDY SAMPLE: A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists. RESULTS: Overall, participants rated all of the approaches highly on both benefit and likelihood of use; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales. CONCLUSIONS: Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals).

Acceptance of internet-based hearing healthcare among adults who fail a hearing screening.

OBJECTIVE: This study measured help-seeking readiness and acceptance of existing internet-based hearing healthcare (IHHC) websites among a group of older adults who failed a hearing screening (Phase 1). It also explored the effects of brief training on participants' acceptance of IHHC (Phase 2). STUDY SAMPLE: Twenty-seven adults (age 55+) who failed a hearing screening participated. DESIGN: During Phase 1 participants were administered the University of Rhode Island Change Assessment (URICA) and patient technology acceptance model (PTAM) Questionnaire. During Phase 2 participants were randomly assigned to a training or control group. Training group participants attended an instructional class on existing IHHC websites. The control group received no training. The PTAM questionnaire was re-administered to both groups 4-6 weeks following the initial assessment. RESULTS: The majority of participants were either considering or preparing to do something about their hearing loss, and were generally accepting of IHHC websites (Phase 1). The participants who underwent brief IHHC training reported increases in hearing healthcare knowledge and slight improvements in computer self-efficacy (Phase 2). CONCLUSIONS: Older adults who fail hearing screenings may be good candidates for IHHC. The incorporation of a simple user-interface and short-term training may optimize the usability of future IHHC programs for this population.

Adult-children's perspectives on a parent's hearing impairment and its impact on their relationship and communication.

OBJECTIVE: The aim of the study was to describe third-party disability experienced by adult-children as a result of hearing impairment (HI) in a parent. DESIGN: Using semi-structured interviews, participants were asked to describe the impact of a parent's HI on their relationship and communication. Interpretative phenomenological analysis, a qualitative method to explore participant's perceptions and viewpoints, was used as the method of analysis. STUDY SAMPLE: Twelve participants between the ages of 22 and 58 who each had a parent with confirmed HI who owned hearing aids. RESULTS: Within the contextual factors of family relationships, communication situations, and the parent's personality, adult-children considered their coping strategies and feelings that arose as a result of the HI. Coping strategies included putting forth effort in communication, yelling as an ineffective communication strategy, and providing support to the parent with HI. The described feelings included frustration, uncertainty, and loss surrounding their communication and relationship with their parent with HI. These feelings arose as a result of implementing coping strategies, plus these feelings drove the employment of coping strategies. CONCLUSIONS: Adult-children of parents with HI experience third-party disability, however, the participation restrictions and activity limitations experienced by children appear less than experienced by spouses.

Perceptions of adults with hearing impairment regarding the promotion of trust in hearing healthcare service delivery.

OBJECTIVE: This paper describes how trust is promoted in adults with hearing impairment within the context of hearing healthcare (HHC) service delivery. DESIGN: Data were analysed from a previously published descriptive qualitative study that explored perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. STUDY SAMPLE: Interview transcripts from 29 adults from four countries with different levels of hearing impairment and different experience with the HHC system were analysed thematically. RESULTS: Patients enter into the HHC system with service expectations resulting in a preconceived level of trust that can vary from low to high. Relational competence, technical competence, commercialized approach, and clinical environment (relevant to both the clinician and the clinic) influence a patient's resulting level of trust. CONCLUSIONS: Trust is evolving rather than static in HHC: Both clinicians and clinics can promote trust. The characteristics of HHC that engender trust are: practicing good communication, supporting shared decision making, displaying technical competence, offering comprehensive hearing rehabilitation, promoting self-management, avoiding a focus on hearing-aid sales, and offering a professional clinic setting.

Perceptions of age and brain in relation to hearing help-seeking and rehabilitation.

OBJECTIVES: This study used a qualitative approach to explore the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. Two superordinate themes, Age and Brain, emerged from prior analyses and are investigated in the present article. DESIGN: In-depth semistructured interviews were completed in four countries with 34 adults (aged 26 to 96 years) with hearing impairment. Participants were asked to "Tell the story of your hearing." Participants included individuals with different levels of experiences in hearing help-seeking and rehabilitation. The themes of Age and Brain emerged from the data based on qualitative content analysis. These major themes were analyzed further using interpretative phenomenology to create models of themes and subthemes as they related to hearing help-seeking and rehabilitation expectations and experience. RESULTS: Age was discussed by 68% of the 34 participants. The data were sorted into three themes: Expectations, Self-Image, and Ways of Coping. Brain was discussed by 50% of the participants. The data were sorted into three themes: Cognitive Operations, Plasticity, and Mental Effort. CONCLUSIONS: Adults with hearing impairment think of their age and their brain as contributing to their hearing impairment, disability, help-seeking, and rehabilitation. Although hearing impairment associated with older age was typically construed as a stigma, not all perceptions of aging and hearing impairment were negative. Some participants viewed older age and its influence on relationships or priorities as a reason for seeking out hearing health care or as the determining factor in deciding to wear hearing aids (HAs). Some expected hearing impairment with older age, thus they found it easier to accept wearing HAs than they may have at a younger age. They discussed the brain in terms of the cognitive operations that may either inhibit or improve speech communication. Participants believed that they could train their brains to improve their communication (and sometimes avoid the need for HAs) or to increase their HA benefit. Age and Brain interconnected in a number of ways. Participants believed that older age led to cognitive decline, which resulted in decreased speech understanding. Participants also believed that the cognitive decline that accompanies older age may limit HA benefit. Hearing healthcare providers may wish to clarify negative messages about age and brain with their patients and provide information about how older brains are capable of changing and benefiting from HA use and comprehensive audiologic rehabilitation programs.

The effect of LACE DVD training in new and experienced hearing aid users.

BACKGROUND: Numerous studies have demonstrated that improving the ability to understand speech in noise can be a difficult task for adults with hearing aids (HAs). If HA users want to improve their speech understanding ability, specific training may be needed. Auditory training (AT) is one type of intervention that may enhance speech recognition abilities for adult HA users. PURPOSE: The purpose of this study was to examine the behavioral effects of an AT program called Listening and Communication Enhancement (LACE) in the DVD format in new and experienced HA users. While some research has been conducted using the computer version of this program, no research to date has been conducted on the efficacy of the DVD version of the LACE training program in both new and experienced HA users. RESEARCH DESIGN: An experimental, prospective repeated measures group design, with random assignment. STUDY SAMPLE: Twenty-nine adults with hearing loss were assigned to one of three groups: new HA plus training, experienced HA plus training, or control (new HA users with no training during the study but provided with training afterward). New HA aid users were randomly assigned to either the training or control group. INTERVENTION: Participants in the training groups completed twenty 30 min training lessons from the LACE DVD program at home over a period of 4 wk. DATA COLLECTION: Participants in both training groups were evaluated at baseline, after 2 wk of training and again after 4 wk of training. Participants in the control group were evaluated at baseline and after 4 wk of HA use. Several objective listening measures were administered including speech in noise, rapid speech, and competing sentences tasks. Subjective measures included evaluating the participants' perception of the intervention as well as their perceptions of functional listening abilities. RESULTS: Findings indicate that both new and experienced users improved their understanding of speech in noise, understanding of competing sentences, and communication function after training in comparison to a control group. Effect size calculations suggested that a larger training effect was observed for new HA users compared to experienced HA users. New HA users also reported greater benefit from training compared to experienced users. AT with the LACE DVD format should be encouraged, particularly among new HA users, to improve understanding in difficult listening conditions.

Standardized patients in audiology: a proposal for a new method of evaluating clinical competence.

BACKGROUND: While accrediting organizations require AuD programs to provide evidence that their students are able to demonstrate knowledge and competencies in specific content areas, there are no generally accepted mechanisms for the assessment and the measurement of these proficiencies. We propose that AuD programs consider developing standardized patient (SP) cases in order to develop consistent summative assessment programs within and across universities. PURPOSE: The purpose of this article is to provide a framework for establishing SP programs to evaluate competencies in AuD students by detailing the history of SP cases and their use, developing a rationale for this method of assessment, and outlining the steps for writing and implementing SP cases. RESEARCH DESIGN: Literature review. RESULTS: SPs have been used to assess clinical competence in medical students for over 50 yr. The prevalence of SP assessment in allied health professions (e.g., dentistry, psychology, pharmacy) has increased over the last two decades but has only gained a limited following in audiology. SP assessment has been implemented in medical education using the Objective Structured Clinical Examination, a multistation, timed exam that uses fictional cases to assess students' clinical abilities. To date, only one published report has been completed that evaluates the use of SPs to assess clinical abilities in audiology students. This article expands upon the work of English et al (2007) and their efforts to use SPs to evaluate counseling abilities. To this end, we describe the steps necessary to write a case, procedures to determine performance requirements, and the need to develop remediation plans. As an example, we include a case that we have developed in order to evaluate vestibular assessment and patient communication skills. CONCLUSIONS: Utilizing SP assessment in audiology education would provide useful means to evaluate competence in a uniform way. Future research is necessary to develop reliable and valid cases that may be implemented across programs. This article aims to serve as a call to audiology programs to begin developing and reporting these cases. Once these are established we can begin to use SP cases for summative assessment.

Conducting qualitative research in audiology: a tutorial.

OBJECTIVE: Qualitative research methodologies are being used more frequently in audiology as it allows for a better understanding of the perspectives of people with hearing impairment. This article describes why and how international interdisciplinary qualitative research can be conducted. DESIGN: This paper is based on a literature review and our recent experience with the conduction of an international interdisciplinary qualitative study in audiology. RESULTS: We describe some available qualitative methods for sampling, data collection, and analysis and we discuss the rationale for choosing particular methods. The focus is on four approaches which have all previously been applied to audiologic research: grounded theory, interpretative phenomenological analysis, conversational analysis, and qualitative content analysis. CONCLUSIONS: This article provides a review of methodological issues useful for those designing qualitative research projects in audiology or needing assistance in the interpretation of qualitative literature.

Hearing help-seeking and rehabilitation: perspectives of adults with hearing impairment.

OBJECTIVE: This study investigated the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. DESIGN: Individual semi-structured interviews were completed. STUDY SAMPLE: In total, 34 adults with hearing impairment in four countries (Australia, Denmark, UK, and USA) participated. Participants had a range of experience with hearing help-seeking and rehabilitation, from never having sought help to being satisfied hearing-aid users. RESULTS: Qualitative content analysis identified four main categories ('perceiving my hearing impairment', 'seeking hearing help', 'using my hearing aids', and 'perspectives and knowledge') and, at the next level, 25 categories. This article reports on the densest categories: they are described, exemplified with interview quotes, and discussed. CONCLUSIONS: People largely described hearing help-seeking and rehabilitation in the context of their daily lives. Adults with hearing impairment rarely described clinical encounters towards hearing help-seeking and rehabilitation as a connected process. They portrayed interactions with clinicians as isolated events rather than chronologically-ordered steps relating to a common goal. Clinical implications of the findings are discussed.

The Hearing Impairment Impact-Significant Other Profile (HII-SOP): a tool to measure hearing loss-related quality of life in spouses of people with hearing loss.

BACKGROUND: Third-party hearing loss-related quality of life (HLQoL) reports measure the third-party disability as a result of communicating regularly with someone with hearing loss. Scales with known psychometric characteristics validated on a diverse subject population are needed in order to describe the activity limitations and participation restrictions experienced by spouses as a result of living with an individual with hearing loss. PURPOSE: The purpose of the present study was to develop a scale to measure third-party HLQoL in spouses of people with hearing loss with acceptable psychometric characteristics. This scale is known as the Hearing Impairment Impact-Significant Other Profile (HII-SOP). RESEARCH DESIGN: In Study 1, the initial test items were developed and evaluated with a factor analysis for adequate construct validity. In Study 2, the internal consistency reliability, the validity, and the test-retest reliability of the revised test were evaluated. STUDY SAMPLE: In Study 1, 120 people between 34 and 87 yr of age participated and in Study 2, 164 people between 23 and 88 yr of age participated. DATA COLLECTION AND ANALYSIS: In Study 1, a 41-item questionnaire was developed based on five content areas: physical adjustment, social activities, emotional reaction, intimate relationship, and change in roles. The scale was submitted to a factor analysis to analyze interrelationships among items, determine the underlying dimensions, and select items for the final scale. In Study 2, the internal consistency reliability, construct validity, and test-retest reliability were evaluated in the revised 20-item questionnaire. The internal-consistency reliability was measured using Cronbach's alpha. Validity was assessed by observing the correlations of the new scale with well-established scales measuring related constructs: overall health-related quality of life, marital communication, HLQoL, and negative affect, in both the person with hearing loss and the spouse. Test-retest reliability was measured in a subset of the spouses who completed the HII-SOP between 2 and 4 wk after the initial scale was completed. RESULTS: The HII-SOP is a 20-item scale with three subscales which measure: (1) the emotions that arise when having a spouse with hearing loss as well as the impact of the hearing loss on the marital relationship, (2) the impact of the hearing loss on the social life of the spouse, and (3) the communication strategies used by the spouse. The scale and its subscales have adequate internal-consistency reliability suggesting that the 20 items do measure a single construct and the subscales do measure distinct subconstructs. The HII-SOP scale was significantly correlated with measures expected to relate to the construct of third-party disability associated with hearing loss. Finally, the HII-SOP scale has adequate test-retest reliability (r = 0.90) and the 95% critical differences is 19.7 points. CONCLUSIONS: The HII-SOP is a scale to measure third-party HLQoL in spouses of individuals with hearing loss. Scores of 20-39 reflect mild third-party disability, scores of 40-59 reflect moderate third-party disability, and scores >60 reflect severe third-party disability associated with hearing loss.

The influence of mood on the perception of hearing-loss related quality of life in people with hearing loss and their significant others.

The purpose of this research was to investigate the congruent/incongruent perceptions of hearing-loss related quality of life between members of couples and to determine how incongruence was affected by individual psychosocial characteristics, specifically measures of mood (negative affect and positive affect), stress, and communication in the marriage. An exploratory correlational analysis was performed on data for 52 couples in which only one member had a hearing loss. In the regression analyses the independent variables were hearing-loss related quality of life scores measured in people with hearing loss, measured in significant others, and differences in hearing-loss related quality of life among members of a couple. The results demonstrate that both in people with hearing loss and their significant others, perceptions of hearing-loss related quality of life is highly correlated with negative mood scores. Incongruence in hearing-loss related quality of life scores reported by members of a couple were highly correlated with negative affect measured within each individual. Future research evaluating the effectiveness of audiologic rehabilitation can use measures of mood as an outcome variable.

Evaluation of an audiological rehabilitation program for spouses of people with hearing loss.

BACKGROUND: Since the psychosocial effects of hearing loss are different in the spouse (SP) than in the person with hearing loss (PHL), it seems reasonable that rehabilitation programs designed for PHLs may need to be adapted to benefit SPs. PURPOSE: To evaluate the effectiveness of training in communication strategies and psychosocial exercises for SPs of PHLs by determining whether SPs who completed the group class had improved mood, reduced stress, improved marital communication, and greater awareness of their partners' hearing loss-related quality of life (HL-QOL) in comparison with SPs who did not participate in a group class. Additionally, to determine whether PHLs of SPs who participated in a group audiological rehabilitation (AR) class had significantly improved mood, reduced stress, improved marital communication, and better HL-QOL scores in comparison with PHLs whose SPs did not participate in a group class. RESEARCH DESIGN: A randomized controlled study. STUDY SAMPLE: A total of 72 individuals participated in the study, 36 PHLs and 36 SPs. The PHLs were hearing aid users or cochlear implant users; the SPs had normal or near normal hearing. INTERVENTION: PHLs in the control group participated in a traditional group AR program while their SPs received no treatment. PHLs in the experimental group also participated in a traditional group AR program while their SPs participated in a treatment program designed for SPs of PHLs. Classes consisted of 90 min sessions meeting once a week for four weeks. DATA COLLECTION AND ANALYSIS: All participants completed questionnaires measuring HL-QOL (the SPs filled out third-party reports of HL-QOL), stress, mood (positive affect and negative affect), and communication in the marriage. Scales were completed three times: prior to the AR program, within two weeks after completing the AR program, and 6 mo later. SP awareness of their PHL's HL-QOL was measured by comparing preclass and 6 mo scores with reported critical difference values. Preclass, postclass and 6 mo data were examined with repeated measures ANOVAs. RESULTS: All SPs reported significant improvements in third-party HL-QOL between the preclass and postclass visit. At the 6 mo visit, these reports remained consistent in the control SPs but declined in the experimental SPs. Awareness of HL-QOL in PHLs was improved in SPs who participated in AR classes and remained consistent in SPs who did not. All SPs demonstrated a trend (moderate effect sizes) for decreased stress and decreased negative affect after they and/or their partners completed the AR program. All PHLs demonstrated significant improvements in HL-QOL, significant reductions in stress, significant decreases in negative affect, and significant improvements in marital communication. There were no differences in outcome across the experimental and control PHLs. CONCLUSIONS: When PHLs participate in an AR program, they receive significant improvements in QOL (quality of life). Congruence (as defined by similar scores) between SP and PHL assessments of HL-QOL improved in the experimental group, suggesting that the principal impact of the AR program on SPs was improved understanding of PHL experiences with hearing loss.

Introduction for the 4th International Meeting on Internet and Audiology Special Issue of the American Journal of Audiology.

[Figure: see text].

The Development of an Internet-Based Decision Coaching Guide to Encourage Audiology Care: The Results of a Participatory Design Approach.

Purpose The purpose of the research described here is to create a theoretically based, interactive online program to motivate adults with untreated hearing loss to seek audiology care. We describe the results of the participatory design (PD) approach used to increase uptake and adherence to the Internet-based program. Method Using information gathered from field experts (n = 7), a program outline was generated by the study team. In keeping with PD principles, multiple focus groups and panels consisting of persons with hearing loss (n = 26), frequent communication partners (n = 6), audiologists (n = 9), and other area experts (n = 16) revised and expanded both content and design of the program in an iterative fashion. Results The proposed program was modified multiple times based on the input of stakeholders throughout the PD process. In particular, the scope of the program shifted from focusing on self-management strategies to decision coaching regarding the choice to visit an audiologist. Other specific program content and activities were modified based on stakeholder input. Conclusions The program evolved dramatically through the influence and input of multiple stakeholders as a result of the implementation of PD principles.

Adult Children's Perspectives on Their Role in Their Parent's Hearing Healthcare Processes.

BACKGROUND: Communication partners play an important role in the hearing healthcare (HHC) process of the person with hearing impairment (HI). However, present research focuses mainly on the role of the spouse; the role of the adult child is often overlooked or understated. PURPOSE: The aim of the study was to describe the role of the adult child in the HHC process of a parent with HI. RESEARCH DESIGN: Using a qualitative study design, participants described their role in their parents' HHC process and the impact of a parent's HI on their relationship and communication in individual semi-structured interviews. STUDY SAMPLE: Twelve adult children of ten parents with HI participated; two sets of siblings were included to gain different perspectives on the HHC process within the same family. DATA COLLECTION AND ANALYSIS: Thematic analysis, a qualitative method to explore participant's perceptions and viewpoints, was used as the method of analysis. RESULTS: The superordinate theme discussed most frequently by participants, communication management, was bolstered by three ideas or pillars: facilitating HHC, communication strategies, and encouraging hearing aid use. Adult children saw themselves as advocates or supporters of their parent's HHC by taking an ongoing and active role in promoting successful communication rather than a role in directing their parent's HHC actions. Within each pillar of communication management, participants' perceptions and actions were modulated by the varying levels of effort and a desire to ask questions to better understand how to help their parent, which in turn influenced their awareness of the HI and HHC options, often resulting in the adult child putting forth new effort. CONCLUSIONS: Whereas the patient journey is often presented to the patient as a linear process, the adult children instead viewed the process of communication management as an ongoing and continuous cycle. The audiologist should be encouraged to involve adult children in the HHC process, as adult children play an important role in everyday communication management.

Can auditory and visual speech perception be trained within a group setting?

PURPOSE: This study attempted to determine whether auditory-only and auditory-visual speech perception could be trained in a group format. METHOD: A randomized controlled trial with at least 16 participants per group was completed. A training-only group completed at least 5 hr of group speech perception training; a training plus psychosocial group completed at least 5 hr of group speech perception training and psychosocial exercises; and a control group did not receive training. Evaluations were conducted before and after training and included analytic and synthetic measures of speech perception, hearing loss-related and generic quality of life scales, and a class evaluation form. RESULTS: No significant group changes were measured on any of the analytic auditory-only or auditory-visual measures of speech perception, yet the majority of training participants (regardless of training group) reported improvement in auditory and auditory-visual speech perception. The training participants demonstrated a significant reduction on the emotional subscale of the hearing loss-related quality of life scale, while the control participants did not demonstrate a change on this subscale. CONCLUSIONS: Benefits of group audiologic rehabilitation classes may not result from an actual improvement in auditory or visual speech perception abilities, but participants still perceive training in these areas as useful.

Internet and Audiology: A Review of the Third International Meeting.

PURPOSE: In this introduction, the four members of the scientific committee for the Third International Meeting on Internet and Audiology describe the meeting that took place at the University of Louisville on July 27-28, 2017. METHOD: This special issue, with a decidedly clinical focus, includes 14 articles that arose from presentations given at the Third International Meeting on Internet and Audiology. All touch upon the theme of innovation as it pertains to teleaudiology and mobile health (mHealth), application of Big Data to audiology, and ethics of internet and telemedicine. CONCLUSION: Innovations in teleaudiology, mHealth, and Internet-based audiology are developing at a rapid pace and thus research in the field must continue. We invite readers to the next International Meeting on Internet and Audiology that will take place in Southampton, England, June 17-18, 2019.

Issues associated with the measurement of psychosocial benefits of group audiologic rehabilitation programs.

The purpose of this review is to describe the psychosocial effects of hearing loss, review the literature that has attempted to measure the psychosocial benefits of group audiologic rehabilitation programs, and offer suggestions for the design of future studies. The psychosocial aspects of hearing loss are multidimensional and may include the emotional, cognitive, interpersonal, behavioral, and physical responses to hearing loss. As a result of the stigma of hearing loss, individuals may isolate themselves, avoid social interactions, and/or bluff their way through communication breakdowns. Participation in group audiologic rehabilitation programs is a straightforward way to deal with the stigma and the loss of social identity associated with hearing loss, and these groups are an ideal forum for teaching communication strategies. Yet, the literature on the efficacy of group audiologic rehabilitation has produced equivocal results. Several factors may have contributed to the lack of psychosocial benefits reported in the literature, including the theoretical framework upon which the program was designed, the actual class content, the effectiveness of the outcome measures, and the demographic characteristics of the participants in the programs. Future research should determine (1) if the theoretical framework and/or the content covered in group audiologic rehabilitation programs influences the psychosocial outcomes, (2) if instructor training influences psychosocial outcomes, (3) the ideal test battery to assess the psychosocial benefits of group audiologic rehabilitation programs, (4) the participant demographic and personality characteristics that influence psychosocial outcomes, and (5) whether experienced hearing aid users have different hearing-loss related psychosocial needs than new hearing aid users.